Harmonic Society



Download 167.81 Kb.
Date conversion05.08.2017
Size167.81 Kb.



Contracting Party:

“Harmonic Society”

Armenian Association of Social Workers (AASW)

Sub-Granting Programme under the SWIC project

Social Workers in Collaboration for Social Change in Eastern Neighbourhood Countries



Reference: EuropeAid/135811/DH/ACT/Multi

Sub-Grant Application Form

Deadline for submission of applications:

March 31, 2017, 18.00 local timetime

Title of the Action:




Location(s) of the Action:



Name of the applicant(s)






Application No




(for official use only)


Instructions for drafting the Application


There is no specific template for the application but the lead applicant must ensure that the text:

  • does not exceed the indicated numbers of pages (A4 size) of Arial 10 characters with 2 cm margins, single line spacing;

  • provides the information requested under the headings below, in the order in which it is requested, and in proportion to its relative importance (see the relevant scores set out in the evaluation grid in the Guidelines for Sub-Grant Applicants of the Sub-Grant Programme);

  • provides full information (as the evaluation will be based solely on the information provided);

  • is drafted as clearly as possible to facilitate the evaluation process.




TABLE OF CONTENTS

1.Information about the applicant(s)

Full Name of the applicant (or leading-applicant)




Legal status




Date of registration




Registration number




Legal address
(place of registration)





Postal (actual) address (if different from legal)




VAT-Number (if applicable)




Telephone number
(fixed and mobile)





Website of the applicant or Facebook page
(if any)





Official legal representative of the leading applicant




Contact person for the Action

Name:

Tel.


E- mail

Co-Applicant
organization 1
(if any)


Name:

Legal status;

Date of establishment:

Contact person:

Tel.


Co-Applicant
organization 2 (if any)


Name:

Legal status;

Date of establishment:

Contact person:

Tel:


Note: Any change in the addresses, phone numbers or other contact details must be notified in writing to the Contracting Party. The Contracting Party will not be held responsible in the event that it cannot contact an applicant.

2.Summary of the Action (max. 2 pages)1



Title of the Action




Location/s of the Action - region(s), area(s) or town(s)/ community(ies) that will benefit from the Action




Total duration of the Action (number of months):




Total budget of the Action
in EUR (including co-financing, if any)




Requested grant contribution in EUR and as a percentage of total eligible costs of the Action

EUR

%


Co-financing (if any) in EUR and as a percentage of total eligible costs of the Action

EUR

%


Information on co-financing

Source of co-financing (Own contribution or donor (specify name))

Cash
(in EUR)


In kind
(equivalent in EUR)






































If co-financing in kind, specify the nature of contribution:2


Objectives of the Action





Target groups and Final beneficiaries

*groups/entities that will directly and indirectly benefit from the Action (quantify where possible)






Expected results
(quantify where possible)





Main activities / steps





3.Background and description of pre-action situation (max. 1 page)

The section should provide information on each of the following questions:



  • State clearly the specific pre-action situation in the target region(s) and/or community(ies) (include quantified data analysis where possible);

  • Provide a detailed analysis of the problems to be addressed by the Action and the need(s) that arise(s) due to these problems, segregated by different target groups / final beneficiaries, if applicable;

  • Describe any other relevant programs by government, local authorities and/or donors (national and international) in the target region(s) / for the target group(s) / the target sector(s) and any relevant gaps identified within these programs the Action intends to address.

4.Description of the Action (3 - 5 pages)

Provide a description of the proposed Action, including all the information requested below:

4.1.Objectives of the Action


  • State and explain the objective(s) of the Action.

  • Describe in which way these objective(s) are relevant to the overall and specific objectives of the call for proposals as defined in paragraph 1.2 of the Guidelines for Sub-Grants.

4.2.Expected results of the Action

  • State and explain the expected results of the Action (quantified where possible).

  • Which quantitative and qualitative changes are expected in the target region(s) / community(ies) at the end of implemented Action?

  • What is the impact of the Action on the target groups / beneficiaries / stakeholders of the Action? How will the Action improve the situation of the target groups and final beneficiaries?

4.3.Target region / location of the Action

  • Explain for each of the target region(s) / community(ies) selected the reasons for the selection. If you intend to work in more than one region / community, explain how you intend to use synergies or establish links between these regions / communities and whether different approaches will be necessary to work in these regions / communities.

  • If you have previously been active in one or several of these target region(s) / community(ies), describe this previous experience.

4.4.Target Group(s) and Final Beneficiaries

  • Who will directly or indirectly benefit from the project? Describe direct and indirect beneficiary groups, their number, their socio-economic characteristics (e.g. social and employment status, number of children, etc.) and possibilities and mechanisms of their involvement in the project activities.

  • Explain how you intend to reach these target group(s) and/or select them, if not the whole target group(s) can be covered by your Action.


4.5.Stakeholders of the Action

  • If not already covered by 4.4, describe the key stakeholder groups of the Action and their attitudes towards the Action.

  • Describe any previous consultations held with them (e.g. during preparation of the Action or previous projects).

4.6.Main activities / steps of the project

Identify and describe each activity (or work package) to be undertaken to produce results.

Do not repeat the Action plan to be provided in section 7, but give more detailed information relating to each activity.

Demonstrate a logical, sequential sequence of activities that contribute to a coherent and consistent project design. Add more tables upon necessity.

Refer to min. 3 of the preferred / obligatory types of activities stated in paragraph 2.3.5. of the Guidelines for Sub-Grants Applicants.

Activity Nr. 1: Insert Activity Title

Justification / short description of Activity Nr. 1




List of concrete sub-activities




Expected results and outputs




Activity Nr. 2: Insert Activity Title

Justification / short description of Activity Nr. 2




List of concrete sub-activities




Expected results and outputs




Activity Nr. 3: Insert Activity Title

Justification / short description of Activity Nr. 3




List of concrete sub-activities




Expected results and outputs




4.7.Relevance to specific subthemes/sectors/areas

Describe



  • how your Action refers to the priority topic of this call, namely to “Inter-agency / Inter-sectorial cooperation on community level with a special focus on social work to strengthen family preservation” (as defined under 2.3.4 of the Guidelines for the call);

  • which activities and measures you have planned in your Action to “analyze / demonstrate how Social Work can contribute to family strengthening and preservation and improved inter-sectorial cooperation on a community or regional level” (i.e. to the obligatory Social Work component of this call as defined under 2.3.5 of the Guidelines)

  • how your Action takes into account other specific requirements stated in the Guidelines for the call, in particular if activities outside the capital are planned.


5.Project Management and Organizational structure of the Action (max 1 page)

The section should provide information on each of the following questions:



  • the organisational structure and the team proposed for the implementation of the Action (please fill in the table below



Function in Action

Responsibilities and main tasks

Partner (name of lead applicant, co-applicant)

Name of suggested project team member



















































  • the role and participation in the Action of the other actors and stakeholders (co-applicant(s), target groups, local authorities, etc.), and the reasons why these roles have been assigned to them;

  • the main means proposed for the implementation of the Action (equipment, materials, and supplies), justifying the need to acquire/rent them.

6.Sustainability of the project (max 1 page)

The section should provide information on each of the following questions:



  • Explain how the Action will be made sustainable after completion. This may include necessary follow-up activities, ownership, dissemination / communication plan, etc. Distinguish between two types of sustainability:

a. Financial sustainability: e.g. financing of follow-up activities, sources of revenue for covering all future operating and maintenance costs.

b. Institutional sustainability: e.g. structures that would allow the results of the Action to continue to be in place after the end of the Action, capacity building, agreements and local ‘ownership’ of Action outcomes.



  • Describe possibilities for replication and extension of the project outcomes.

  • Describe the main (possible) risks for the project and the suggested measures to overcome those risks (see table below)

Risks

Low / Middle / High

Ways to overcome those risks

Risk 1:







Risk 2:







Risk 3:







7.Action plan for implementing the Action

The Action plan should be sufficiently detailed to give an overview of the preparation and implementation of each activity. It should at least give details on each of the main activities defined under section 4.6. The Action plan will be drawn up using the following format:



N

ACTIVITIES

Responsible person / party

06/17

07/17

08/17

09/17

10/17

11/17

12/17

01/18

02/18

03/18




























































































































































































































































































































































































































































































































8.Budget, amount requested from the Contracting Party and other expected sources of funding

Fill in Annex B to the Sub-Grant Guidelines for Applicants to provide information on:


For further information, see the Sub-Grant Guidelines for applicants.

Please note that the cost of the Action must be stated in EURO.




9.Applicants’ experience

This information will be used to assess whether you have sufficient experience of managing Actions / projects, in particular whether you have demonstrable experience of implementing at least two projects, each with a min. project budget of at least 33% of the requested grant amount, , preferably related to the social field, in Armenia within the last 5 years, thereof at least one mainly targeting one or several regions outside the capital.

9.1.Lead applicant’s experience



Please describe briefly your experience. Max. 1 page per experience and max. 5 reference projects (within the last 5 years).

Please add more tables, if necessary.

Name of Applicant:




Project title:




Objectives:




Role:

    • Coordinator / Lead applicant

    • Co-beneficiary

    • Affiliated entity

    • Sub-contractor

    • Other _____________________________

Target region(s) / community(ies)

Total budget of the Action
(EUR)


Budget of the Applicant
(EUR)


Donor(s) to the Action (name(s))

Partner organization(s)
(if any)


Dates (from..to)
dd/mm/yyyy



















Sector(s)

    • Humanitarian assistance

    • Legal services

    • Educational services (trainings, extracurricular activities)

    • Health services (medical consultations, medical supplies, rehabilitation services)

    • Psychosocial services (individual/group/family counselling)

    • Inclusion and participation-oriented services (cultural / sport activities)

    • Community mobilization

    • Advocacy and lobbying

    • Employment/Entrepreneurship support

    • Other _________________

Beneficiaries /
Target groups


    • Children

    • Families

    • Women

    • Youth / adolescents

    • People / Children with physical / mental disabilities

    • People with medical/health needs

    • Elderly people

    • Legal offenders / people at risk

    • People addicted to drugs, alcohol or substances

    • Refugees or displaced persons

    • Minorities / LGBT

    • Media

    • Community

    • CSO/national or local government

    • Other _____________________



Name of Applicant:




Project title:




Objectives:




Role:

    • Coordinator / Lead applicant

    • Co-beneficiary

    • Affiliated entity

    • Sub-contractor

    • Other _____________________________

Target region(s) / community(ies)

Total budget of the Action
(EUR)


Budget of the Applicant
(EUR)


Donor(s) to the Action (name(s))

Partner organization(s)
(if any)


Dates (from..to)
dd/mm/yyyy



















Sector(s)

    • Humanitarian assistance

    • Legal services

    • Educational services (trainings, extracurricular activities)

    • Health services (medical consultations, medical supplies, rehabilitation services)

    • Psychosocial services (individual/group/family counselling)

    • Inclusion and participation-oriented services (cultural / sport activities)

    • Community mobilization

    • Advocacy and lobbying

    • Employment/Entrepreneurship support

    • Other _________________

Beneficiaries /
Target groups


    • Children

    • Families

    • Women

    • Youth / adolescents

    • People / Children with physical / mental disabilities

    • People with medical/health needs

    • Elderly people

    • Legal offenders / people at risk

    • People addicted to drugs, alcohol or substances

    • Refugees or displaced persons

    • Minorities / LGBT

    • Media

    • Community

    • CSO/national or local government

    • Other _____________________

9.2.Co-applicant(s)'s experience (if applicable)

Co-applicants can, but are not required to provide evidence on one or several successfully implemented projects. If you want to show relevant project experience for one or several co-applicants, please use the same table as for the Lead Applicant and add it below.

Each co-applicant is obligatorily required to prove that min. two employees that will be involved in the Action on behalf of the co-applicant have been involved in the coordination or implementation of other donor-funded projects for min. 6 months. Please fill in the table below:




Name of Co-Applicant:




Information on first employee the co-applicant suggests to involve in the Action:

First name, surname:




Date of birth:




Highest level of education:




Reference project 1 the employee was involved in:

Name of project:



Reference project 2 the employee was involved in:

Name of project:

Name of implementing organisation:



Name of implementing organisation:


Function of employee in project:


Function of employee in project:


Donor(s) of project:


Donor(s) of project:


Duration of involvement of employee in reference project (months):


Duration of involvement of employee in reference project (months):


Contact data of referee in implementing organisation:

Name:


Tel.:

E-mail:



Contact data of referee in implementing organisation:

Name:


Tel.:

E-mail:



Information on second employee the co-applicant suggests to involve in the Action:

First name, surname:




Date of birth:




Highest level of education:




Reference project 1 the employee was involved in:

Name of project:



Reference project 2 the employee was involved in:

Name of project:

Name of implementing organisation:



Name of implementing organisation:


Function of employee in project:


Function of employee in project:


Donor(s) of project:


Donor(s) of project:


Duration of involvement of employee in reference project (months):


Duration of involvement of employee in reference project (months):


Contact data of referee in implementing organisation:

Name:


Tel.:

E-mail:



Contact data of referee in implementing organisation:

Name:


Tel.:

E-mail:



10.

11.Mandate for co-applicant(s)

The co-applicant(s) authorize(s) the Applicant <indicate the name of the organisation> to submit on their behalf the present application form and to sign the grant contract with the “Harmonic Society” Armenian Association of Social Workers ("Contracting Party"), as well as, to be represented by the Applicant in all matters concerning this grant contract.

I have read and approved the contents of the proposal submitted to the Contracting Authority. I undertake to comply with the principles of good partnership practice.



Name:




Organisation:




Position:




Signature and stamp:




Date and place:




12.Declaration by the Lead Applicant

The lead applicant, represented by the undersigned, being the authorised signatory of the lead applicant, and in the context of the present application, representing any co-applicant(s) in the proposed Action, hereby declares that:



  • the lead applicant is directly responsible for the preparation, management and implementation of the Action with the co-applicant(s), if any, and is not acting as an intermediary;

  • the lead applicant and each co-applicant are eligible in accordance with the criteria set out under sections 2.2.1 and 2.2.2 of the Sub-Grants Programme Guidelines for Sub-Grant Applicants;

  • the information provided in this application is correct and was filled in to the best of my knowledge and belief;

  • neither me nor the indicated other applicants (when there is the case) are bankrupt or undergoing judicial, volunteer or forced liquidation;

  • payments / grants made to me from other organisations or within other programmes have not been suspended;

  • we are ready to make the co-financing contributions to the presented Action as indicated in points 2 and 8 of this application.

I am aware that I can be excluded from the Sub-Grants Programme for declarations that do not correspond to the reality.  

Signed on behalf of the lead applicant:



Name:




Organisation:




Position:




Signature and stamp:




Date and place:




13.Checklist for the full application form

Before sending your application, please check that each of the following criteria have been met in full and tick them off

Tick the items off below

Title of the proposal:



Yes

No

PART 1 (ADMINISTRATIVE)







  1. The submission deadline has been met.







  1. The correct grant application form has been used.







  1. The declaration by the lead applicant has been filled in and signed.







  1. The proposal is typed and is in English or Armenian







  1. One original and one copy are included.







  1. An electronic version of the proposal has been enclosed on an electronic medium or sent via e-mail.







  1. Each co-applicant has completed and signed the mandate and the mandate is included. Please write ‘Not applicable’ (NA) if you have no co-applicant(s).







  1. The budget is enclosed, in balance, presented in the format requested, and stated in EUR.







PART 2 (ELIGIBILITY)







  1. The Action will be implemented in Armenia outside of Yerevan







  1. The duration of the Action is between 8 and 10 (the minimum and maximum allowed).







  1. The requested contribution is between 20.000 EUR and 45.000 EUR (the minimum and maximum allowed).







  1. The supporting documents listed below were submitted in accordance with the Guidelines (Section 2.4)

  1. Copy of the registration certificate of each applicant organization;

  2. Copy of the approved charter/bylaw/articles of association of each applicant organization;

  3. If co-financing is provided: Written statement on the amount, type and sources of co-financing contribution within the framework of the project, which has to be approved (signed and sealed) by an official representative of the applicant organization;

  4. Project references of the lead applicant;

  5. For co-applicants (if any): previous project experience of min. 2 employees to be involved in the Action;

  6. Copy of the latest accounts (profit and loss account and balance sheet for the last financial year for which which the accounts have been closed) or the latest financial statement submitted to local tax authorities of each applicant

  7. Recent fiscal statement (not older than 30 days) of each applicant organization issued by competent local authority.







Sub-Grants Programme under the project “Social Workers in Collaboration for Social Change in Eastern Neighbourhood Region

1 If the grant Application is prepared in local language, then the “Summary of the Action” has to be submitted in English; if the grant Application is prepared in English, then the “Summary of the Action” has to be prepared in local language.

2 Contributions in kind mean the provision of goods or services to Sub-Grant Beneficiaries free of charge by a third party and may be of the following nature: goods, equipment, buildings (own or rented), work rendered (by oneself and other workers on a voluntary basis), etc.

625_SGP_Annex A_Grant Application Form Page of


The database is protected by copyright ©ininet.org 2016
send message

    Main page